Specialty Care Programs
In 2014, Partners developed a Specialty Program to engage specialists in our efforts to improve quality and reduce health care costs. Our philosophy is that early and coordinated access, through the application of tools such as bi-directional referral management systems and virtual visit capabilities will help reduce costs. Additional areas of focus include appropriateness and optimal outcomes.
We organize our work into two main areas:
- Building the medical neighborhood to address chronic, longitudinal care, including
- Implementing tools to manage episodes of care, including
Below is a detailed description of our programs.
The E-Consults program uses an electronic referral platform that allows primary care physicians to request an “E-Consult” from a specialist. The ability to ask specific questions about a diagnosis or treatment plan can provide an alternative pathway for some patients and may be faster and more efficient than an in-person visit. If an in-person visit is required, this process can also enable better visit preparation. For example, necessary testing (e.g. lab work) and pre-visit work ups can be discussed during the E-consult and conducted prior to the visit. This increases the usefulness of the in-person visit and avoids the inconvenience of patients having to come back for multiple appointments. The program is live at Brigham and Women's Hospital and Massachusetts General Hospital and will soon be moving to our community affiliates.
PCP/Specialty Collaborative Care Agreements
To ensure that patients who see multiple doctors receive well coordinated care, we developed the PCP/Specialty Collaborative Care Agreements. In this program, primary care physicians and specialists work together to define clear roles and responsibilities and develop formalized plans to improve the quality of care.
Key areas of focus include:
- Providing more timely access to appointments for patients
- Improving care coordination such as testing, medication management, and routine follow up care;
- Helping patients avoid emergency room visits or unnecessary hospital admits; and
- Clarifying with whom patients should communicate for urgent issues.
These agreements, which are designed to avoid both gaps and redundancy in care, are being built across the Partner network with select specialties and will be implemented 2016 and onwards.
Virtual Visits and eVisits
Virtual visits are video-based encounters between providers and patients that occur in real time using secure web-based technology. Virtual visits are being offered across Partners for routine follow-up visits for patients with an established relationship with their physicians. They offer patients a convenient alternative to in-person visits by reducing costs and time associated with travelling to the doctor’s office. For providers, conducting virtual visits may be more convenient, saving time traveling between facilities and increasing overall efficiency. For more information, see MGH TeleHealth Program.
eVisits are on-line medical consultations that serve as an alternative to in-person visits. Unlike virtual visits, eVisits do not occur in real-time. Instead of an in-person follow-up visit, patients use a secure website to submit answers to questions about their health that have been sent to them by their own physician. Upon reviewing the patient’s answers, the physician determines an appropriate next course of action which might include no change in treatment, a revision to therapy, and/or a request to schedule another eVisit, telephone call, or in-person visit.
Procedural Decision Support
To help assure that patients being assessed for surgical procedures are receiving the safest and most appropriate care, we developed a web-based decision support tool called PrOE (Procedure Decision Support). PrOE integrates clinical guidelines, appropriate use criteria, and personalized risk models to inform surgical decision-making for both patients and providers. Using PrOE, patients receive a personalized consent form that includes their specific risks and benefits for the procedure and education materials to help patients make informed decisions. PrOE also helps to standardize treatment options and promotes collaboration among our specialists. Currently, PrOE is available in Cardiac Surgery, Cardiology, Vascular Surgery, General Surgery, Orthopedic Surgery and Spine Surgery. Our goal is to expand this program across Partners for select procedures over the next few years.
Patient-Reported Outcomes (PROMs) measure what matter most to patients – symptoms, functional status, and quality of life rather than, for example, how many days a patient stayed in the hospital. PROMs are measured through structured questionnaires using computerized tablets in clinic waiting rooms and from home. PROMs are being used by more than 20 medical and surgical specialties at more than 50 locations across Partners. We expect to collect 75,000 surveys by the end of 2015 and 150,000 by the end of 2016. By focusing on objective measurement of symptoms and function, providers can use routine PROMs data collection to augment their ability to provide patients with the best clinical outcomes. By comparing data among institutions and treatment options, aggregate PROMs data can be used to improve quality, aid in public reporting and, eventually, orient care toward the outcomes that matter most to patients.
View our PROMs video above.